Characterizing barriers to closing cross-institutional referral loops: Workflow and information flow analysis

Area of Science:

• Health Services Research
• Clinical Informatics
• Healthcare Management

Background:

• The specialty referral process involves primary care clinicians referring patients to specialists, necessitating robust care coordination and health information exchange.
• Breakdowns in workflow and information flow frequently impede the "closing of the referral loop," delaying or preventing referrers from receiving essential consultant visit notes, especially during cross-institutional referrals.

Purpose of the Study:

• To describe and map the existing specialty referral process within clinical settings.
• To identify and characterize the specific work system barriers that negatively affect the performance of the referral process.

Main Methods:

• Qualitative study involving interviews with referring clinicians and specialist consultants.
• Exploration of perceived workflows, identified barriers, and reported clinical outcomes.
• Workflow analysis informed by direct stakeholder input.

Main Results:

• The study successfully mapped the referral process as it currently operates in clinics.
• Key work system barriers impacting referral performance were identified and characterized.
• Stakeholder interviews provided insights into workflow inefficiencies and information flow challenges.

Conclusions:

• Understanding and addressing identified work system barriers is crucial for improving the specialty referral process.
• Effective care coordination and health information exchange are vital for closing the referral loop.
• Workflow analysis and stakeholder engagement are essential for optimizing patient care transitions.